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What Employer's Need to Know about the SHOP (Small Business Health Options Program)

What is Small Business Health Options Program (SHOP)?

The Small Business Health Options Program, established under the Affordable Care Act (ACA), provides businesses with the option to purchase medical and dental coverage for their employees through the “SHOP Marketplace” or exchange. Eligible employers with less than 50 or 100 full-time equivalent employees (FTEs), depending upon the state, can apply for coverage any time of the year and also claim small business health tax credits by visiting https://www.healthcare.gov/small-businesses/employers/

What are the benefits of using the Small Business Options Program (SHOP)?

Employers can compare the benefits of different health plans side-by-side while having the flexibility to choose from the following coverage options:

Offer your employees one plan, or let them choose from multiple

Offer only health coverage, only dental coverage, or both

Choose how much you pay toward your employees' premiums, and whether to offer coverage to their dependents

Decide how long new employees must wait before enrolling

Eligible companies with fewer than 25 employees may qualify for a Small Business Health Care Tax Credit, which is worth up to 50% of premium costs.

Business owners can decide how long the initial enrollment period is, and the length of time a new employee must wait before joining the plan.

Applying, choosing plans, managing coverage, and paying premiums can all be handled online.

An employer can use their current agent or broker, or work with a SHOP-registered agent or broker, or manage everything directly.

Deductions can be taken on the portion of premium costs not covered by the tax credit.

There is a SHOP Marketplace in every state. Companies must have an office or employee work site within the SHOP’s service area in order to use that particular SHOP.

How do I know if my business qualifies to use The Small Business Health Options Program (SHOP)?

The SHOP Marketplace is available to eligible employers with 1-50 full-time equivalent (FTE) employees or in some states employers with 1-100 full-time equivalent (FTE) employees.

To use the SHOP Marketplace, employers must offer coverage to all of their full-time employees.

Employers must have an office or employee work site within the state SHOP Marketplace they elect to use.

In many states, an employer must have at least 70% of their employees enroll in the SHOP Marketplace to be eligible for participation. If an employer does not meet the minimum participation requirement, they can still enroll in SHOP coverage from November 15 to December 15 of any year. During this period employers can enroll without meeting a minimum participation requirement. When determining the participation rate for businesses enrollment, employees with other forms of coverage are included in participation rate calculation which makes it easier for employers to offer SHOP Marketplace coverage.

How does an employer know if they are eligible for the Small Business Health Care Tax Credit?

The Small Business Health Care Tax Credit can be worth up to 50% of an employer’s premium contributions (up to 35% for tax-exempt employers). To be eligible a company must meet the following requirements:

Fewer than 25 full-time equivalent employees (FTE)

An average employee salary of $51,600 per year or less adjusted yearly for inflation

A contribution of at least 50% of your full-time employees’ premium costs

Employees enrolled in coverage through the SHOP Marketplace

How does the SHOP Marketplace Work?

The SHOP Marketplace is a user-friendly website that is similar to a car insurance or travel website. Employers may shop and choose their plan, manage coverage, and even pay their premiums all online.

Employers must create an account and enter the necessary information to be provided a side by side price and plan comparison.

Employers must apply for eligibility by filling out an application and entering information about the business and their employees.

To apply by phone call the SHOP Small Employer Call Center at 1-800-706-7893 (TTY: 711)

Mail the completed application to:

Health Insurance Marketplace

465 Industrial Blvd.

London, KY 40750-0001

Eligible employers may choose a health insurance plan.

Then begin enrollment by letting employees know they can sign up for coverage.